South Carolina referral program a 'win-win-win'

Patients 'down on their luck' can become part of practice

Columbia, S.C. — When people here with a toothache go to a Palmetto Health emergency department seeking care, they often walk away with more than temporary pain relief: a referral to a dentist.

That's because of a successful ER referral initiative launched in 2012 that provided 1,460 emergency dental visits to 833 patients from two counties the health care system services in fiscal year 2015. The numbers mark a decrease in the system's emergency department utilization for dental issues during almost every month for the last year and a half, according to Vince Ford, chief community health services officer for Palmetto Health. The setup also saves the health system about $500 per visit for patients seeking emergency dental care, while also benefiting partnering dentists who agree to participate. In turn, the health system provides financial support to the dentists.

"We're really proud of it," said Dr. Noble Cooper, a Columbia dentist who helped rally local dentists to participate — along with the South Carolina Dental Association and its executive director, Phil Latham. Dr. Cooper is among the dentists who participate in the program, seeing one or two referred patients per week, he said.

"We enjoy helping people," he said. "I think that's part of our duty as dental clinicians — to help the community."

The dental referral program, dubbed the Midlands Dental Initiative, was born after a series of community health days organized by local health care systems in previous years, which helped underserved patients who were invited to take advantage of medical, vision and dental care at no cost for one day. By far, Mr. Ford said, "one of the greatest needs was for dental care." Dental services covered under Medicaid in South Carolina are limited.

"We had patients traveling across state lines. We had patients who were willing to wait for 24 hours," Mr. Ford said. "The very first person at the event one year brought a chair and cooler and slept outside overnight — and she was one of those seeking dental care."

Seeing the need for care, along with the hospital system's expensive and consistent stream of patients with dental issues visiting its emergency department, hospital administrators decided to see if they could partner with local dentists who would agree to treat patients who need dental care. In turn, the hospital would reimburse participant dentists at a discounted rate.

Working with the South Carolina Dental Association, program organizers began calling local dentists to see who might join, taking 2 to 5 patients per month, Mr. Ford said.

"It just blossomed and bloomed from there," Mr. Ford said, adding that 20 dentists agreed to participate in the first few months.

Today, while the hospital system's bottom line is benefitting from the referral program, more importantly, the patients are being helped, too, Mr. Ford said.

Dr. Ruges Stockton, a Columbia dentist, who has been part of the program almost since its inception, said he has many patients referred to him from the health care system who return for continuation of care.

"We've had many patients down on their luck or experiencing tough times," he said.

"They've rebounded and become part of the practice."

Aside from building his patient base, opening his office up to underserved patients contributes to the mission of Dr. Stockton's father, Clyde Stockton, who practiced alongside his son until his death in 2012, he said.

"He taught me that your ultimate goal is to help others," Dr. Stockton said of his father.

The ADA Council on Access, Prevention and Interprofessional Relations has made helping develop ER referral programs across the country one of its Action for Dental Health priorities in 2016.

Mr. Ford said other communities could use the Palmetto Health model to establish referral programs. His best advice, he said, is to sit down with potential stakeholders, start a conversation with the state dental association and involve other community partners.
Collaboration, or what Mr. Ford calls "synergy," is key.

"If we put our resources and your resources together, we can make a major dent in a public health issue," he said.

Mr. Ford call the program a "win-win-win" for all involved.

"You've got a healthier person who is out of pain and discomfort. You've got a reduced load in the ER and you've put them in most appropriate care. You're also working with a partnering dentist who's making a little bit of money," he said. "The community benefits overall."

The American Dental Association's Action for Dental Health campaign, a national movement launched to address the dental health crisis in the U.S., has published tips for starting local ER referral programs. Visit ADA.org/action for more information.